Series 707.7.4P - Request to Ride an Existing Magnet School Bus
Adopted: January 2010
Revised:
This form should be completed by intradistrict and interdistrict transfer students that do not qualify for magnet school transportation but are able to use an existing magnet school bus.
Date of application Transportation start date
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student name (last, first, middle initial) birth date _____ _____ _____
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sex M F |
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parent/guardian name (last, first, middle initial) |
telephone number
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parent/guardian address (residence)
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city |
zip code
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student address (if different from parent/guardian) |
city |
zip code
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resident district of student |
city |
resident district number
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previous school attended
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grade attended
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requested District 196 magnet school
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grade attending
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student will use bus: to school only ❏ from school only ❏ both ❏ |
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existing bus stop location (specify address of stop at which you wish student to be picked up and dropped off)
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As a parent/guardian, I agree to provide for my child's safety while going to and from the District 196 bus stop prior to boarding and after disembarking from the bus.
A new form must be filled out prior to each school year. Requests will be approved after August 1.
_______________________________________ ___________________________
signature of parent/guardian date
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OFFICE USE ONLY |
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date received: |
magnet student: new ❏ existing ❏ |
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student ID: |
date sent to transportation: |
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last school attended: |
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requested start date: |
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notes: |
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Return to:
Independent School District 196
Magnet School Specialist
3455 153rd Street West
Rosemount, MN 55068
Procedures/707.7.4P/1-19-10